NPIMap

Organization Active NPI

Premier Family Medicine & Urgent Care Clinic Inc.

  • Primary Care Clinic/Center
  • Columbus, GA
National Provider Identifier
1104178409
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
63508 Issued in GA
Legal business name
PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC.
Practice address
1315 Delauney Ave
201 A
Columbus, GA 31901-2367
Phone
(706) 507-3747
Fax
(706) 507-3638
NPI assigned
Oct 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Megbewe Godpower Okoroba, M.DNPI 1437233947
Title
Ceo
Phone
(646) 528-7117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 63508 GA Primary

Addresses

Primary practice location

1315 Delauney Ave
201 A
Columbus, GA 31901-2367

Mailing address

1315 Delauney Ave
201A
Columbus, GA 31901-2367
Phone (706) 507-3747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130108000191 GA Part B Supplier - Clinic/Group Practice 1658524350 Receives reassigned benefits from 1 practitioner
Practice locations: Columbus, GA

National Provider Directory

National Provider Directory

Locations

1315 Delauney Ave
#201A
Columbus, GA 31901
Phone (706) 507-3747

1201 18th St
Columbus, GA 31901
Phone (706) 322-4950

1315 Delauney Ave
Ste 201A
Columbus, GA 31901
Phone (706) 221-2194

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1104178409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 DELAUNEY AVE",
            "address_2": "201A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012367",
            "telephone_number": "706-507-3747",
            "fax_number": "706-507-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 DELAUNEY AVE",
            "address_2": "201 A",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319012367",
            "telephone_number": "706-507-3747",
            "fax_number": "706-507-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "OKOROBA",
        "authorized_official_first_name": "MEGBEWE",
        "authorized_official_middle_name": "GODPOWER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "646-528-7117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "63508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.